Primary Care

Physicians writing on KevinMD about the primary care shortage, the fifteen-minute visit, panel size, what primary care is paid against procedural specialties, continuity, and the administrative load that has grown around the work. Four maintained records draw on this archive: Primary care: what physicians say, in their own words, Direct primary care: what physicians say, in their own words, Prior authorization: what physicians say, in their own words, and Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words.

Are insurance companies responsible for increasing health costs?

Stephen C. Schimpff, MD

Health Policy

September 28, 2012

The insurance system for healthcare is perverse. The individual is not the customer of the healthcare company; in most cases it is the employer or the government (i.e., Medicare, Medicaid). They physician works for the insurer who determines for what and for how much the doctor is paid. But are the insurance companies the blame that is often placed on them for our current state of affairs?

This system abrogates the …

Can the AMA be fixed?

George Lundberg, MD

Physician

September 27, 2012

There is nothing more powerful than an idea whose time has come. There is nothing less powerful than an idea whose time has come and gone.

In 1846, and for more than 100 years after that, the American Medical Association as a nationwide organization for all physicians was a powerful idea whose time had come. It worked well for many things and OK for many more.

Then, in the 1970s, 80s, 90s, …

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Can the AMA be fixed?

Health IT: We can fix health care, and we know exactly how to do it

Margalit Gur-Arie

Health Technology

September 27, 2012

High tech people are very enthusiastic people. We are optimistic, confident and creative and if I may be allowed to say so, really, really smart. We start out by saying “Hello World!” not “Hi, I’m Jack or Jane”. We hail the entire Universe and assume it knows who we are, or that it will soon find out, because the sky is not the limit and we are going to change …

Generic drug denied, try a brand name first

Rob Lamberts, MD

Medications

September 27, 2012

I got an unusual request last week. I written a prescription of a generic medication (which has been generic for a couple of years) and the prescription was denied by the insurance carrier. The reason for denial: I had to try a brand-name medication first.

Stop. Read that again. They wouldn’t allow me to give a prescription for the (cheaper) generic drug because I had to try the brand-name medication first. This …

Death came in whatever he might be wearing at the time

Greg Smith, MD

Physician

September 26, 2012

He was just a kid.

Fifteen I think, something like that, too young to have experienced too much in life at that point, but old enough to die by his own hand.

His father, only a year and change older than me, had already dealt with some issues of his own. Diabetes, a member of his family on both sides for generations, had already taken its toll on him by the time …

5 things that I want my patients to know

Leana Wen, MD

Physician

September 26, 2012

Today’s healthcare consumer is constantly barraged with conflicting information. Does wine prevent or predispose to cancer? Should I eat certain foods or avoid them? Is this new medication going to hurt me or help me? Many issues are still controversial, but there are some things that have a large amount of evidence behind them.

1. Antibiotics will not help the common cold. Colds are caused by viruses, and antibiotics kill bacteria, which …

Policy experts need to lead by storytelling

Kenneth Lin, MD

Physician

September 26, 2012

Public health leaders must often tell people things that they don’t really want to hear. “Stop smoking.” “Eat a healthier diet.” “Exercise for at least 30 minutes each day.” To motivate people to heed these messages, leaders construct simple narratives to communicate the potential harms of undesired health behaviors and the benefits of desired ones. Who wants to spend their golden years tethered to an oxygen tank for every moment …

Doctors should care about global climate change

George Lundberg, MD

Physician

September 26, 2012

Most humans, even those who are educated, can read and write, and have studied some science, seem to have a hard time comprehending unpleasant future realities, absent personal experience.

Some say that people learn most from their own mistakes. If true, that makes widespread prevention of anticipated calamities very difficult.

And I am not only talking about people who are deeply into religion and superstition, and those who send politicians who proudly …

4 reasons why doctors need to drive health care technology

David Lee Scher, MD

Health Technology

September 25, 2012

The physician’s role is drastically changing. More and more physicians are becoming institutional employees. More patient encounters are performed via non-physician providers. The increasing regulatory demands on physicians are consuming an inordinate amount of their time. Stress and burnout are universal to some degree. Both the financial and emotional rewards of practicing medicine have greatly diminished. They are becoming more quality control officers than healthcare providers. However, physicians will never …

Preserving the doctor-patient encounter in the face of technology

David Mokotoff, MD

Physician

September 25, 2012

I recently was on vacation in Rocky Mountain National Park. Suspended on an overlook of astonishing beauty at 11,000 feet above sea level, I stared out at the tundra and bits of August snow that still clung to the highest peaks. Suddenly my attention was snapped from the massive boulders and landscapes to the ringing of my cell phone. It was a referring doctor asking me about a mutual patient …

How my military experience helped me become a better doctor

Jared Solomon, MD

Physician

September 25, 2012

Not long ago, I read an article titled, “What health care can learn from the military.” As a former member of the US Army, I was intrigued. I learned many things in the military that I use everyday in the clinic. Before that, I employed things I learned to help me get through medical school. My military experience gave me some fantastic skills. None were brought up in …

How colonoscopies are like airline tickets

Michael Kirsch, MD

Physician

September 24, 2012

One would think that a physician who earns his living billing patients would be conversant with the prices of his services. Not this doctor. I am queried periodically by patients asking how much I charge for a colonoscopy.

Of course, every physician recognizes that this question is not phrased properly. It doesn’t matter what we charge; it’s what an insurance company determines we will be paid. I might believe that your …

Being a Good Samaritan isn’t always comfortable

Suzanne Koven, MD

Physician

September 24, 2012

On a night flight from Boston to San Francisco a voice came over the loudspeaker. “If there’s a doctor on board, would you please identify yourself by pressing your call bell?”

I reached up to hit the button, shrugging nonchalantly in response to my seat mate’s questioning look. “Duty calls,” my shrug was meant to convey.

But I didn’t feel nonchalant. What I felt was approximately two parts excitement and one part …

Oversights contribute to a simplified view of elder care

Natasha Bhuyan, MD

Physician

September 23, 2012

On a picnic blanket at Piestewa Peak in Phoenix, AZ, Rowena passed around orange honey almonds while Barbara read an Elizabeth Chase Allen poem to us. My friend Dosia pointed out the growing audience of curious squirrels hoping we would drop a few treats. The conversation turned to favorite springtime memories; our laughter cut through the quiet of the desert. Nadine brought out a layered chocolate cake for her boyfriend …

Why I love the USPSTF

George Lundberg, MD

Physician

September 23, 2012

Readers of this column will already know that I am a great fan of the United States Preventive Services Task Force (USPSTF). But they may not know how far back that fan support goes.

The USPSTF was founded in 1984 to produce evidence-based policies for preventive care. In about 1986, while editor of JAMA, I was asked to consider becoming the primary destination for the USPSTF reports, after appropriate peer review, …

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Why I love the USPSTF

How to improve communication in the medical setting

Donald Tex Bryant

Physician

September 23, 2012

“What we have here is a failure to communicate.” A famous quote from the movie Cool Hand Luke. As many know poor communication is common in healthcare.

Consider the following examples.

According to Charles Duhigg in his newly released book, The Power of Habit, Rhode Island Hospital was one of the nation’s leading medical institutions. It was the teaching hospital for Brown University and the only Level I trauma center in southeastern …

Do your homework when looking for a new doctor

Vivian E. von Gruenigen, MD

Physician

September 21, 2012

You are in charge of your own healthcare. Equally important is research that reveals that most women are in charge of their family’s health as well. But you’re not alone – you need a physician partner for you and your family, and sometimes, it can be challenging to find the right one.

I always recommend doing your homework and researching the reputation of the physicians, surgeons and nurse practitioners who will …

How to destroy health IT innovation

Douglas Perednia, MD

Health Technology

September 21, 2012

I have spent a good portion of his career working to come up with ways to make healthcare better, faster and cheaper through the appropriate use of computer and information technologies. Given the vitriol that I have periodically heaped upon many of the electronic medical record systems commonly deployed and mandated by the government, this enthusiasm for computers and telecommunications may come as a bit of a surprise to some …

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How to destroy health IT innovation

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